Keyhole surgery is a minimally invasive surgical approach that utilizes several small incisions to access the interior of the body. Laparoscopic, thorascopic, and arthroscopic surgeries are examples of specific types of keyhole surgeries in common practice today. Usually, specialized elongated instruments are used to perform these intracorporeal procedures, which are visualized with the aid of an endoscope attached to a light source. Thus, such surgical procedures are also commonly referred to as “endoscopic procedures.” Many of these procedures require a variety of such instruments for specific tasks. The use of these instruments in an intracorporeal environment can be a challenging and time-consuming process.
Several training devices and techniques have been developed that can reduce or eliminate the difficulties and time involved with certain procedures, such as grasping, cutting, or dissecting tissues during keyhole surgeries. However, the rapid development and deployment of novel, minimally invasive instruments presents the surgical educator with significant challenges in rapidly developing new training devices. For example, several types of grasping, shearing, and dissecting instruments, such as the ENDO GRASP™, ENDO SHEAR™, and ENDO DISSECT™ instruments (Covidien AG), can be effectively used for a variety of endoscopic procedures. Specialized endoscopic dissectors are often utilized prior to implantation of a gastric band to excise or dissect tissue and can also be used to assist with the implantation of gastric bands (see, for example, the Realize™ adjustable gastric band, Ethicon Endo-Surgery, Inc., (a Johnson & Johnson company)). Other types of endoscopic dissectors that can be utilized in thorascopic surgery are the WOLF™ LUMITIP™ (AtriCure, Inc. West Chester, Ohio), which has a lighted working end, and the CARDIOBLATE® NAVIGATOR™ (Medtronic, Inc., Minneapolis, Minn.), which has a mult-link, lighted working end. The use of all of these instruments often requires skills significantly different from those used for conventional “open cavity” surgery. As such, there can be a significant learning curve involved in developing the necessary skills to efficiently and effectively use these and other new instruments. (Tan, Andrew et al., J. Endourology 2005, 19(9):1104-1108). This is unacceptable in today's medical environment where throughput pressures in the operating room leave little or no time for delays or even minor mistakes. Surgeons, medical professionals, and other trainees must often find ways to perfect their skills outside of the operating room.
In order to achieve proficiency, trainees must be instructed on the correct use of new instruments and spend valuable time practicing the use of the instrumentation. However, maximizing a trainee's proficiency in a limited amount of time, while ensuring patient safety, has also proven to be a challenge. Traditionally, to obtain realistic experience, training has been conducted using actual instruments on excised organs, cadavers, or living animals. This type of training usually requires surgeons to spend time traveling to a training location to engage in practice sessions. Further, to enhance the reality of the training, surgeons often utilize actual instruments during practice, which, of course, become contaminated during use. Because the instruments are usually designed and manufactured for one-time use and cannot be sterilized, each practice session requires opening and using a new instrument. This can be a considerable expense over several practice sessions and with several trainees all using a new instrument each time they engage in training exercises.
With advancements in computer simulations and virtual reality, there are a variety of other methods that have been developed for such practice that can reduce the amount of travel required for training sessions. For example, life-size anatomically correct models, videoscopic trainers, and virtual environment software (SIMBIONIX™) have all been utilized to train surgeons in the use of specific instruments. Most of the simulator devices currently available are designed to train a specific procedure or use of a specific instrument. While many are transportable or at least movable, they are usually large, unwieldy and not designed or amenable to being relocated frequently or over large distances. Further, the cost of such devices usually limits the number available at a facility, necessitating that they be located in a generally accessible location. Thus, medical professionals are still required in most circumstances to travel to another location, even within a facility, to engage in training and practice with such devices. The inconvenience of having to go to another area, move a large device, set up a training session, or wait for an available time to train on a device can all discourage medical professionals from engaging in regular training for new devices.
Virtual reality and computerized environments have also been developed that simulate the intracorporeal surgical environments in which surgeons can develop proficiency with various techniques and instruments. Some of these virtual environments have also utilized haptic feedback devices (SensAble Technologies, Woburn, Mass.; Simbionix™, Cleveland, Ohio) to simulate the feel of touching or interacting with real tissues or organs. (Kim, M., Punak, S., Cendan, J., Kurenov, S., and Peters, J. 2006. Exploiting graphics hardware for haptic authoring. Medicine Meets Virtual Reality (MMVR) 14, Jan. 25-27 2006, Long Beach, Calif., IOS Press, Amsterdam, Studies in Health Technology and Informatics (SHTI), 2006, 119:255-260; Kim, M., Tianyun, Ni, Cendan, J., Kurenov, S., and Peters, J. A Haptic-enabled Toolkit for Illustration of Procedures in Surgery (TIPS). Medicine Meets Virtual Reality (MMVR15), Feb. 6-9, 2007, Long Beach, Calif. Studies in Health Technology and Informatics, Volume 125, Pages 209-213, 2007; Hubbard, P., Collision Detection for Interactive Graphics Applications. IEEE Transactions on Visualisation and Computer Graphics. 1995; 1, No 3:218-230). But, training in a virtual environment is most effective when it actually emulates real-life situations. Thus, interacting within a virtual environment with devices and techniques that do not have a realistic look and feel of actually used instruments may not provide adequate surgical training and experience. Further, without some type of performance assessment of the training experience, it can be difficult to determine when the skills of a surgeon have developed sufficiently for use in an actual surgical procedure.
There is a need for a more convenient and less time-consuming method by which surgeons or other medical professional trainees can develop the necessary skills to efficiently utilize new and specialized surgical instruments. The ability to use and/or practice improved instruments and techniques would be greatly facilitated if medical professionals could learn and practice using new instruments at times and locations that are available and convenient. An ideal device is one that can be located in close proximity to where a medical professional spends most of their free time, such as in their office or laboratory. It should further be quick to initiate and use, allowing them to obtain needed skills or practice already acquired skills during random free time. Ideally, it would be a device that permits training with several interchangeable input devices, or handles, such that a surgeon need only change the handle and initiate a corresponding computer program to train with a different device. A further need exists to provide realistic training experiences without resorting to the on-going expense of using multiple, actual surgical devices in practice sessions. It should also provide realistically simulated instrumentation and environments for practicing techniques, which can provide surgeons with practical experience and skills. Still further, the ability to assess a surgeon's skills with a particular technique or device can assist in determining when they are sufficiently skilled to use the device in a real life situation.